[Complaints after total joint arthroplasty: caused by infection or metal hypersensitivity?]

Besides periprosthetic joint infection, metal hypersensitivity should be considered when complaints persist after total joint arthroplasty. To date, there is no consensus on the diagnosis, and believers and non-believers of metal hypersensitivity exist. The pathogenesis of metal hypersensitivity is complex and involves a type-4 delayed hypersensitivity reaction with both a cutaneous and systemic response. It is unclear if complaints after total joint arthroplasty (after eliminating other causes) are caused by metal hypersensitivity. Furthermore, it is not known whether sensitization is a cause or a consequence of complaints after total joint arthroplasty. Currently, the patch test is the best screening test to diagnose metal hypersensitivity, but the accuracy has not been defined. We present a female patient with a painful left elbow three years after total elbow replacement. Because of the increasing volume of total joint prostheses, we aim to create awareness for metal hypersensitivity and the according diagnostic dilemmas.